In the Doctor’s Office, a Neglected Resource

When it comes to providing health care for an aging nation, the bad news is no longer news. We already lack sufficient numbers of geriatricians and other professionals — nurses, social workers, pharmacists, aides — trained to care for the elderly, and the shortage is projected to increase.

The good news, confirmed by a study in the Journal of the American Geriatrics Society, is that nurse practitioners can markedly improve the quality of care for older patients.

This article in The New York Times‘s health section “The New Old Age” reports on a recent study revealing that nurse practitioners can, in many cases, dramatically improve the quality of patient care.

When it came to treating depression, patients seeing a doctor and a nurse practitioner received about the same care as those treated by doctors alone. In both groups, patients received 60 percent to 63 percent of recommended care.

But when patients showed up with one of the other three conditions, the addition of nurse practitioners meant much higher scores. Patients who saw a nurse practitioner along with a doctor received 80 percent of the recommended assessments and treatments for falls (compared with 34 percent for those who only saw a doctor), 59 percent for dementia (versus 38 percent) and 66 percent for incontinence (versus a particularly dismal 19 percent).

Dr. David Reuben, director of geriatrics at the University of California, Los Angeles and lead author of the study, explains the benefits of a team approach to medical management that uses both doctors and nurse practitioners:

“There are certain things doctors do well, certain things they don’t do well, certain things nurse practitioners do better,” he said. He added that he sympathized with primary care doctors working with elderly patients who have many chronic conditions: “The job is too big. It’s too complicated. There’s too much to do.”